Solid Tumors Flashcards
Breast Cancer Risks
Early Menarche Last menopause Nulliparous Full pregnancy after 30yo Chest wall Radiation prior to 30yo Obesity Alcohol Vitamin D Deficiency BRCA gene HRT after menopause
BRCA testing Indications
1 with bilateral breast cancer 1 male with breast cancer 1 with ovarian and breast cancer 2+ with breast cancer with 1 dx <50yo 2+ with ovarian and breast combination 2+ with ovarian at any age 3+ with breast cancer at any age
Breast Cancer Prophylaxis indications
If gail model, >1.7% in women >35yo or has lobar carcinoma in situ or ductal carcinoma, then can be placed on tamoxifen pre-menopausal or raloxifene/ exemestane following menopause
Breast Cancer Screening in Known BRCA 1/2 genes or other high risk
MRI of breasts at age 25
Mammography at age 30
Ovarian Cancer Screening at age 30yo - semiannual with US, CA -125, pelvic exams
BSO indicated by age 35yo to reduce risk of breast cancer and ovarian cancer
Other high risk: if chest wall radiation received between age 10-30yo, start with MRI.
DCIS - treatment
excision plus radiation plus hormonal therapy
Invasive Breast Cancers (I-II) treatment
- excision with radiation OR mastectomy
- – mastectomy if chest wall involvement, >5cm, or involves more than 1 quadrant
- – if excision and >5cm- may try neo-adjuvant - Radiation to chest wall if any positive LN
- Systemic Chemotherapy
- – if hormone positive then with hormone ones
- – if hormone receptor negative, HER-2 positive, high grade, lymph node positive then real chemo and
- - if triple negative: real chemo - hormone therapy following
- during excision do a LN biopsy- sentinel vs axillary dissection if positive and LN involvement
Invasive breast cancers (III-IV) treatment
- chemo
- excision
- radiation
- Hormone therapy
Ovarian Cancer Protective Factors
- Child Bearing
- Birth control x15 years
- Hysterectomy
Ovarian Cancer
- SX
- Diagnosis
symptoms: abdominal pain, bloating, ascites, bleeding, weight loss
Diagnosis
- US- solid tumor
- CT/MRI pelvis, abdomen, chest
- Surgical exploration is the definitive diagnosis - also has a mortality benefit if the early grade tumor.
Ovarian Cancer stages and treatment
I - confined to ovaries- surgical removal ONLY
II- high grade features or mets through pelvis but not beyond- sugery and chemo
III - mets to abdomen - surgery and systemic vs intra-peritoneal chemo
IV- Mets beyond abdomen - surgery and chemo
Cryoreductive surgery first then chemo however *in patients with high risk okay to do chemo first then surgery (ex: recent MI, needing plavix)
Cervical Cancer diagnosis
- suspicion with visualization of mass vs screening vs symptoms (discharge, bleeding)
- formal diagnosis with biopsy of mass, colposcopy or conization
Cervical cancer staging and Treatment
- Stage 1 (in situ): hysterectomy /surgical resection
- Stage 2 (extension but not to pelvic wall): chemoradiation
- Stage 3 (extension to pelvic wall): chemoradiation
- Stage 4 (beyond pelvic wall)
chemo- cisplatin
Prostate Cancer Risk stratification
Low Risk
- Gleason <8, T1c graded PSA <15
High Risk
- Gleason >8, >TIC graded, PSA >15/20
Prostate Cancer Treatment
- low risk
- Local disease
- high risk
- Low risk with >10-year life expectancy: Active surveillance with PSA, DRE
- Local Disease: Treat locally with external beam radiotherapy, brachytherapy or radical prostatectomy
- High Risk: Treat with androgen deprivation therapy with GnRH agonist- leuprolide
Prostate Cancer Treatment
- Special Cases-
- Following definitive therapy with a rising PSA: tx with GnRH
- If failed GnRH and still progresses can add flutamide, ketoconazole, estrogen, or steroids
Prostate Cancer Treatment in patients with metastatic disease to bone
- Bisphosphonates
- external beam radiotherapy - treat specific bone sites
- Radium 223- multiple painful bone sites
Colorectal Cancer Stage
stage 1: does not penetrate full thickness
Stage 2: full thickness with possible pericolon fat penetration
Stage 3: LN 1+
Stage 4: Metastatic
Colon Cancer Treatment
Stage 1: resection
Stage 2: Resection (unless high risk features then also chemo)
Stage 3: surgery followed by chemotherapy
Stage 4: palliative chemo and surgery for palliative if would provide comfort
- Chemo: FOLFOX, Capcitabine, 5-FU, or leucovorin
Rectal Cancer Treatment
Stage 1: resection
Stage 2-3: Chemo/radiation before surgery with chemotherapy after surgery
Stage 4: palliative
Anal Cancer Treatment
radiation and mitomycin with 5-FU
Melanoma Therapy
- excision:
- 5 cm for in situ lesions, 1 cm for melanomas with less than 1 mm of invasion, and 2 cm for melanomas with deeper invasion
- LN biopsy if 1mm thick
- if >4mm thic or LN involvement then adjuvant immunotherapy- Interferon Alpha
- If metastatic at a few sites- try to resect
- if metastatic assess for V600 as may be responsive to targeted therapy vemurafenib if poor performance status or more advanced disease
Breast Lump
<35yo
<35YO or pregnant
Start with US:
—– if cystic - drain fluid. (if bloody fluid send for cytology)
—– if mass: needs to be biopsied even if characteristic are consistent with fibroadenoma (FNA or biopsy)
Breast Lump >35yo
> 35yo
Start with Mammogram:
— Even if it is normal- biopsy it (Core needle if solid mass, FNA if cystic)
— if Core need non-diagnostic then perform excisional biopsy
